Aortic Root Replacement And Aortic Valve Sparing Through Mini Partial Sternotomy.
Jakub P. Staromłyński1, Anna Witkowska1, Radoslaw Smoczynski1, Pawel Stachurski1, Maciej Bartczak1, Wojciech Sarnowski1, Dominik Drobinski1, Janusz Sierdzinski2, Piotr Suwalski1.
1Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland, 2Medical University, Warsaw, Poland.
BACKGROUND: Minimally invasive cardiac surgery is becoming more and more popular. However there is still little data on minimally invasive approach for patients with aortic root aneurysm. In following study we wanted to present partial upper sternotomy approach for these patients. METHODS: Between November 2011 and December 2017 163 patients with aortic aneurysms were included to our study. The surgical access was via mini upper partial V sternotomy through 3rd or 4th intercostal space. Figure 1. CPB was provided via direct aortic cannulation and two stage cannula to right atrium. According to our previous experience we set that 67 mm of aortic diameter as a exclusion criteria of minimally invasive approach. RESULTS: Totally we performed 163 minimally invasive procedure. In detail were performed: in 70 patients (42,9%) supracoronary graft, in 32 patients (19,6%), supracoronary graft and AVR in 32 patients (19,6%), in 31 patients (19,0%) we performed Bentall procedure (mechanical graft), in 12 patients (7,3%) bio-Bentall procedure and in 18 patients (11,0%) David procedure. In the group of aortic root aneurysm mean (SD) age was 62.9±12,0 years; mean BMI (kg/m2) was 28,3 ±4,1. Preoperative comorbidities included insulin-dependent DM in 4,9% , previous PCI in 1,6%. The mean EF was 55.6±9.9 %. The mean EuroScore II was 3,1±4,3 %. In all group we did not observe conversion to full median sternotomy. Reopening for bleeding was necessary in 3 patients (4,9%). We didn't observe any neurological incidents, deep wound infection and vascular complication. In 5 patients were observed superficial wound infections required aimed antibiotical therapy. The average stay in ICU were 2.2± 2.1 days. In first 12 hours 70 % patients were extubated. During first 24 hours we observed mean drainage- 465,0±234,5 ml. Blood transfusion rate was: 0.8±1,2, platelets transfusion was 0,3± 1.2. 30 days mortality was 1,6 %. The Kaplan-Meier 5-years survival curve was 93% of survivability in all group of patients. Figure 2. CONCLUSIONS: Minimally invasive procedures via mini upper partial V sternotomy are safe and feasible methods in consecutive all-comers. Due to decreased tissue traumatization it provides better haemostasis. Small incision and only partial upper sternotomy enable faster recovery. In this group of patients the most benefits were observed in: small blood platelets units transfusion, early extubation (chest stability) and low hospital mortality. 
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